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Course of post-traumatic stress disorder and health care utilisation among resettled refugees in the Netherlands

Majda Lamkaddem1*, Karien Stronks1, Walter D Devillé234, Miranda Olff5, Annette AM Gerritsen6 and Marie-Louise Essink-Bot1

Author Affiliations

1 Department of Public Health, Faculty of Medicine, University of Amsterdam, Amsterdam, the Netherlands

2 Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands

3 Medical Anthropology and Sociology Unit, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, the Netherlands

4 Pharos, Utrecht, the Netherlands

5 Center for Psychological Trauma, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands & Arq Psychotrauma Expert Group, Diemen, the Netherlands

6 Epi Results, Louis Trichardt, South Africa

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BMC Psychiatry 2014, 14:90  doi:10.1186/1471-244X-14-90

Published: 27 March 2014



Post-traumatic stress disorder (PTSD) is a major health problem among refugees worldwide. After resettlement, the prevalence of PTSD remains high despite the fact that various PTSD treatments are known to be effective.


We examined the course of PTSD and the role of mental health care utilisation at a 7-year interval (2003–2010) among a cohort of refugees from Iran, Afghanistan, and Somalia after resettlement in the Netherlands.


The unchanged high prevalence of PTSD (16.3% in 2003 and 15.2% in 2010) was attributable in part to late onset of PTSD symptoms (half of the respondents with PTSD at T2 were new cases for whom PTSD developed after 2003). The second reason concerned the low use of mental health care services at T1. Whereas the multivariate analyses showed the effectiveness of mental health care, only 21% of respondents with PTSD at T1 had had contact with a mental health care provider at that time. Use of mental health care during the first wave increased the odds of improvement in PTSD symptoms between both measurements (OR 7.58, 95% CI 1.01; 56.85).


The findings of this study suggest there are two possible explanations for the persistently high prevalence of PTSD among refugees. One is the late onset of PTSD and the other is the low utilisation of mental health care. Health care professionals should be aware of these issues, especially given the effectiveness of mental health care for this condition.